Kaiser Permanente Total Health: A Bold GoalEast Midlands, National Health ServiceNovember 2013

Alide Chase, SVP Medicare Clinical Operations and Population Care

We are committed to helping our members, our workforce, their families, and our communities achieve Total Health

through the services we provide and by promoting clinical, behavioral, environmental, and social actions that improve

the health of all people.

Total Health is a state of complete physical, mental and social well-being for all people.

To be a Leader in Total Health by making lives better.

Kaiser Permanente Strategic Vision

Video “Stay Longer”

Total Health: Support Our Members Through All Stages of Life

Returning to Health

Healthy AgingLiving Well withChronic Conditions

Staying HealthyTotal

Health

Big Concepts

Shift from Disease Management to Population Care

Embracing Total Health Care Transformation Patient/Family Activation Social and Community Activation

Drivers of Health

Many Factors Shape HealthHealth is driven by multiple factors that are intricately linked – of which

medical care is one component. Drivers of Health

Source: McGinnis et al, Health Affairs, 2002

Family History and Genetics

30%

Environmentaland Social

Factors20%

Personal Behaviors 40%

Medical Care

10%

…we are developing a more sophisticated analytical model to deepen our understanding of effective interventions.

Social & Economic Factors

Physical Environments

Health Outcomes And Wellbeing

Prog

ram

s an

d Po

licie

s

• Education• Employment

• Income• Family & social

support• Community safety

• Culture

• Built environment• Food environment• Media/information

environment• Environmental quality

Health Behaviors & Other Individual

Factors

• Diet & activity• Tobacco use• Alcohol use• Unsafe sex• Genetics

• Spirituality• Resilience• Activation

Clinical Care and Prevention

• Access to care• Quality of care

• Clinic-community integration

• Physiology

• Disease and injury

• Health and function

• Wellbeing

Settings: Home Workplace School Neighborhood Clinic Virtual

Adapted from County Health Rankings, 2010 and M. Stiefel, 2012. Draft: 9/15/2012

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2009

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Rate of Obesity According to BMI

Source: Sturm 2003

The Problem of Extreme Obesity in Children

Prevalence of extreme obesity by race/ethnicity in study of SCAL KP members during 2007-2008, n>710,000

0

1

2

3

4

5

6

7

8

9

10

Non-HispanicCaucasian

Hispanic Caucasian African-American Asian or PacificIslander

Perc

ent b

y ra

ce/e

thni

c gr

oup

Boys

Girls4.2%3.3%

9.4%

6.5%

7.3%9.1%

4.5%

2.2%

Koebnick C. (July 2010). Prevalence of Extreme Obesity in a Multiethnic Cohort of Children and Adolescents, Journal of Pediatrics, V 57.

“I think we’re looking at a first generation of children who may live less long than their parents as a result of the consequences of overweight and type 2 diabetes.”

The Epidemic of Overweight and Obesity

www.discoveryhealthCME.com, N Engl J Med Vol. 352(11) March 2005, pp. 1138-1145

What does it mean?

What We’re Up Against

What We’re Up Against

Pulmonary diseaseabnormal functionobstructive sleep apneahypoventilation syndrome

Nonalcoholic fatty liver diseasesteatosissteatohepatitiscirrhosis

Coronary heart disease Diabetes Dyslipidemia Hypertension

Gynecologic abnormalitiesabnormal mensesinfertilitypolycystic ovarian syndrome

Osteoarthritis

Skin

Gall bladder disease

Cancerbreast, uterus, cervixcolon, esophagus, pancreaskidney, prostate

Phlebitisvenous stasis

Plantar Fasciitis

Excess weight increases risk of….Idiopathic intracranial hypertension

StrokeCataracts

Severe pancreatitis

Why Total Health? Integrated Approach to Risk Factors and Disease

RISK FACTORS

Unhealthy DietInactivity

TobaccoHarmful use of

Alcohol

Diabetes

Cardiovascular Disease

Cancer

Chronic RespiratoryDisease

Support Individuals Encourage Groups

Change CommunitiesTrack Outcomes

Diseases + Risk Factors Kaiser Permanente Actions

We Must Address Health At All LevelsDeploying Kaiser Permanente Assets for Total Health

1Neighborhood /

Community

Society

Individual / Family

Home / School /Worksite

Physical and Mental Health Care“Body, Mind and Spirit”

Community Health Initiatives

Environmental Stewardship

Clinical Prevention

Access to Social and

Economical Supports

Health Education

Public InformationPublic Policy

Researchand Technology

Walking Promotion

Worksite/Workforce Wellness

Disrupt Current Defaults …

Confidential – For Internal Use Only

… to Create Optimal Defaults for Total Health

20

Kaiser Permanente’s Approach to Total Health

Total Health will require a coordinated set of activities, focusing on some key initial areas while developing core capabilities and enhancing efforts on work underway.

Total HealthFocus Areas

Core Capabilities“Fundamentals”

Applications of Total Health

Focus as first and relatively complete demonstrations of Total

Health, done everywhere in KP

Essential components needed to realize Total Health

Work underway butTotal Health lens can help deepen the work and re-

double our efforts

A Strategic Approach to Delivering Total Health

Focus on Schools andKaiser Permanente’s Workforce

Key Strategies

Peer-to-peer learning

Youth engagement

Parent & community

engagement

Wellness champions at

all levels

District Leadership

engagement

Primary Goal• Improved Health• Productivity, academic

achievement, schools census as co-benefits

Focus Areas• Healthy Eating• Active Living• School Climate

Targets• Students• Staff and teachers• School environment

Healthy Schools: Our Aim

Healthy Schools: Why Schools?

Benefit to Family/Community

Benefit to KP

Benefit to School

Tier 3

Unique

EnhancementsTier 2

Intensive Consultation &

Capacity Building

Tier 1 Ready-to-use Tools & Resources

* Lower Reach / Higher Intensity

* Higher Reach / Lower Intensity

Healthy Schools: Organizing an Approach to Schools

Tools for Schools and Kids

Create a work culture and environment that supports Kaiser Permanente’s workforce in making healthy lifestyle choices

and to become the healthiest workforce in health care.

Workforce Wellness: Becoming a Leader

Healthy Eating

Healthy Physical Environment

Healthy Activity at Work

Workforce Wellness: Where to Start

Getting our Workforce Walking

31

Website that’s About Your Goals and Needs

• Member selects goals

• Member decides what’s important

• Creates direct virtual connection to provider and resources

Applying Total Health

CLINICAL EXECUTION

ONLINE ENGAGEMENT

ENVIRONMENTAL AND COMMUNITY STRATEGIES

Behavior Change Strategies

We Have the Tools – Exercise As Vital Sign

Confidential – For Internal Use Only

Smith, John W

WHAT IT DOES:Hopp2IT empowers individuals to be healthier with the use of incentives and gamification. Includes a social media component to partner up with individuals and teams for “Healthy Opportunities” in a fun and easy way. Mobile app began piloting internally within IT workforce in January 2013.

Hopp2IT - Pilot

Areas of strongest focus for the future

Total Health is a Campaign

And we are not alone….Institute of Medicine:

Accelerating Progress in Obesity Prevention (May 2012)

Total Health Dashboard

Behavioral Health

Alcohol/Substances

Social Health

Healthy Eating

No measure – placeholder only

Overall Functional Status and Well Being

TBD - Placeholder for Depression Metric

TBD – Placeholder for metric

TBD – Coordinate with Community Benefits

TBD- Placeholder for Alcohol/Substances Metric

The road ahead is challenging…but we can find a way.